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Review and Update on Slipped Capital Epiphysis

Posted on: 11/30/2006
In this detailed article, a condition called slipped capital femoral epiphysis (SCFE) is reviewed. SCFE is a common hip problem in adolescents. In this condition, the growth center of the hip (the capital femoral epiphysis) actually slips backwards on the top of the femur (the thighbone).

The condition can be classified in several ways. The traditional method is based on history, symptoms, and the results of examination. Using this method the stages are labeled pre-slip, acute slip, chronic slip, and acute-on-chronic slip.

More modern groupings are based on how stable the growth plate is and whether or not the child can walk. The newer classification describes SCFE as stable or unstable. X-rays are used to describe the severity of SCFE as mild, moderate, or severe.

SCFE occurs most often in overweight boys of Pacific Island or African Ancestry. It does affect Caucasians and Native Americans but not as often. There may also be endocrine and hormonal factors involved. Left untreated, the hip becomes unstable. Symptoms increase and function decreases.

Loss of blood supply and death of the bone called necrosis can occur. As an adult, the affected individual may develop degenerative arthritis. There are many ways to treat this condition to avoid complications now and problems later.

Surgery can include fixation with a single-screw or multiple pins. Bone graft taken from the pelvis can be used inside the femoral neck to hold the femoral head in place. The use of a hip spica cast on both sides is no longer advised. In some cases, more extensive surgery may be needed. Each of these procedures is described in detail. Advantages and disadvantages of each are mentioned.

The authors conclude the best treatment for stable SCFE is single-screw fixation. Afterwards, the child uses crutches and partial weight-bearing. Gradual progression to full weight-bearing without crutches is advised. If the condition only affects one hip, the surgeon must evaluate the need to treat the other side to prevent similar problems from occurring.

Unstable SCFE requires surgery right away. Any blood in the joint must be removed and the hip stabilized. The child remains on crutches with no weight put on the leg for six to eight weeks. The goal is to stabilize the hip joint with the fewest problems or complications afterwards.

References:
David D. Aronsson, MD, et al. Slipped Capital Femoral Epiphysis: Current Concepts. In Journal of the American Academy of Orthopaedic Surgeons. November 2006. Vol. 14. No. 12. Pp. 666-679.

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